Healthcare Provider Details

I. General information

NPI: 1952307043
Provider Name (Legal Business Name): THOMAS C DELL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 RIVER RD
EAST CHINA MI
48054-2909
US

IV. Provider business mailing address

3930 RIVER RD UNIT 28
EAST CHINA MI
48054-2919
US

V. Phone/Fax

Practice location:
  • Phone: 810-329-2024
  • Fax:
Mailing address:
  • Phone: 810-329-0841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704139055
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: